Methotrexate or Imuran?

[loisann11]

I guess I am one of the lucky ones, today my Doc says I am doing great, all numbers are where they should be. I was only diagnosed about 4 months ago and looks like I get to go on maintenance already. I didn't know about this phase however. I have already done Rituxin, Bactrim, 60mg prednisone, D3, Pepcid, etc. and am already down to 5mg of prednisone. Doc had talked about doing another Rituxin in Oct. but now says I don't need it.

He wants to start me on either Imuran or Methotrexate for 12 months, gave me my choice. I will also take Bactrim and get to go down to 5mg prednisone every other day.

So which has less side effects or seems to work best for some of you? I appreciate any help you can give me with this choice. Thanks

[Psyborg]

Generally Methotrexate is the stand by drug. It's probably a bit harsher on your system, but not substantially. I will say I think MTX maintained my remission better than Imuran did.

[vdub]

I've been on mtx maintenance for 4 years and don't have any issues. Its an old standby and relatively inexpensive. I'm currently on 8 tabs a week (20mg once a wk), but my dosage has varied. I don't even feel 20mg's. At 10 tabs (25mg) I feel some side effects. I suspect he'll put you 8 or less per week.

[Wegetarian]

A rheumy told me that he had patients who have been on MTX for 10+ years and never complained about any issues. MTX was what I was using, it would give me nausea though. I know some people take medicine against the nausea, but it wasn't unbearable for me - just an uncomfortable feeling that I sometimes might feel for a few days. Unfortunately MTX didn't seem to work for me as I had a flare even though I was still on 25mg/week. Don't get me wrong though, I was happy that they selected MTX when I got diagnosed as from what I read back then it didn't seem to cause many adverse effects compared to for instance CTX.

After my cyclo IV's the plan is to switch me to Azathioprine (of which Imuran is a brand name), so I'll have experience from that later. One interesting thing I noticed is that some people will get adverse side effects, but that could be tested for in advance with a gene tests. I asked my doc, and she said they don't regularly perform that test - but I'll ask if it could be done by my private doc since even though the chance is small I'd rather know for sure. Its mentioned on the Wikipedia page, even though I don't think the text is that clear.

Azathioprine - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Azathioprine)


The enzyme thiopurine S-methyltransferase (http://en.wikipedia.org/wiki/Thiopurine_S-methyltransferase) (TPMT) is responsible for various activation and deactivation steps in azathioprine's mechanism of action, and genetic polymorphisms (http://en.wikipedia.org/wiki/Polymorphism_(biology)) of TPMT leads to decreased methylation and decreased inactivation of 6MP.[24] (http://en.wikipedia.org/wiki/Azathioprine#cite_note-pmid17691917-24) This can result in dangerous bone marrow suppression,[5] (http://en.wikipedia.org/wiki/Azathioprine#cite_note-pmid12891528-5) and an assay of TPMT in red blood cells (http://en.wikipedia.org/wiki/Red_blood_cell) or a TPMT gene test (http://en.wikipedia.org/wiki/Gene_test) can avoid this complication

So dunno, can't really recommend one over the other as I have no experience with Aza and haven't even read much about it.

[eyeopps]

I just went through that appointment today. My last cyclo infusion was this morning. My Rheumy recommended going on Imuran because she and my Nephrologist still have concerns with my kidney function. My creatinine levels are still a high. Not high enough to require dialysis. My Rheumy, who specializes in vasculitis, said that MTX requires constant adjustment because of my kidney issues, hence I will go on Imuran.

My maintenance dose will end up at 125mg per day. (gradually increased over three weeks) I am not familiar with what the normal dose is. I have read it is a calculation of body weight and intensity of the Weggies.

Good luck with your decision.

[loisann11]

I chose Imuran and they are giving me 200MG daily. I don't think I am having any side effects and will have labs done in 3 days to see if it is working. Seems like a high dose to me... Does 200mg seem high?

[drz]

I chose Imuran and they are giving me 200MG daily. I don't think I am having any side effects and will have labs done in 3 days to see if it is working. Seems like a high dose to me... Does 200mg seem high?

Depends upon your weight and health of your liver. It was my max dosage but my liver couldn't handle that amount so they cut back to 175. For some one weighing 200 pounds with a good liver and no other meds acting on the liver the dosage should be OK. Your lab work will tell if the dosage is OK and you should feel the decrease in Weg symptoms too as you improve or move into drug induced remission.

[cjhnsn29]

I started taking methrotrextate and my SED rate was 120 when we started now it's down to 80 still a little ways to go but seems to be helping me.

[Pete]

I couldn't tolerate immuran due to genetic intolerance. Since July 2012, I've been taking mtx at dosages ranging from 15-20 mg/day, depending upon how my labs looked. I'm at 17.5 mg/day (and dropping to 3 mg/day of pred tomorrow). I also take 1 mg/day of folic acid to prevent hair loss. I'm doing well on this regimen.

Alcohol and mtx don't mix well. For the first year, I almost totally abstained. Now, I have a glass or two of wine once a month or so. I've also found some non-alcoholic beers that are pretty good. See the thread about mtx and alcohol for more info.

[Wegetarian]

I've been taking mtx at dosages ranging from 15-20 mg/day, depending upon how my labs looked. I'm at 17.5 mg/day

You are taking that much daily? I've never heard of anyone on that high dosages. 25mg / once a week has been the max I heard the use for Wegs, and I guess some split that up into smaller doses. At least I remember Alysia telling that she takes it on multiple days to minimize the nausea.

Is there any specific reason they have you on such high dosages? I heard many people get stomach problems even with the 25mg /week level and move to injecting it. For me the plan was to take 25mg/week, and drop it off with 5mg each year.

[Pete]

My bad!! Mtx dosages are weekly. Good catch!

[LisaT]

I was miserable (nauseous 24/7) on methotrexate and prefer Imuran, UNLESS it is the cause of my brutal headaches which I have yet to determine. I was on 100 mg but when I was having trouble lowering the prednisone my rheumy decided to try a higher dose so I'm now on 150. I'm not feeling well but I don't think this is why. Think it's so individual but it sounds as though perhaps Imuran is easier on the kidneys and/or liver? Maybe ask your dr. The pros and cons of each as well, in case we've all missed something. I personally could not stand self-injecting either, I actually still get nauseous just thinking about it.

[mrtmeo]

Hi Loisann,
Are you saying that you are ANCA negative at the 4 month mark?
Is it 4 months from your first Rtx infusion?

[gilders]

Since first diagnosed almost 20 years ago I've been on Imuran for about 14 years. I couldn't have Mtx due to kidney damage and couldn't tollerate cyclophos. The combination of prednisolone and imuran has always worked well for me, even to treat severe flares.
I've suffered almost all the possible side effects of prednisolone, but seemes to tolerate imuran very well.
But during my most recent relapse the pred + imuran combo doesn't seem to be working as well as usual. I don't know if imuran is anything like antibiotics which become less effective the more you use them or if this flare is been more stubborn than usual. The other thing is that I now have immature, odd shaped red blood cells. My renal doc thinks this could be due to imuran, but the blood specialist doesn't agree. A bone and bone marrow biopsy was done a few month back which showed no cancer, but didn't provide any answers.

I'd recommend imuran as it has worked well for many years for me and the blood issues I'm having haven't been proved to be caused by imuran.

[mrtmeo]

Since first diagnosed almost 20 years ago I've been on Imuran for about 14 years. I couldn't have Mtx due to kidney damage and couldn't tollerate cyclophos. The combination of prednisolone and imuran has always worked well for me, even to treat severe flares.
I've suffered almost all the possible side effects of prednisolone, but seemes to tolerate imuran very well.
But during my most recent relapse the pred + imuran combo doesn't seem to be working as well as usual. I don't know if imuran is anything like antibiotics which become less effective the more you use them or if this flare is been more stubborn than usual. The other thing is that I now have immature, odd shaped red blood cells. My renal doc thinks this could be due to imuran, but the blood specialist doesn't agree. A bone and bone marrow biopsy was done a few month back which showed no cancer, but didn't provide any answers.

I'd recommend imuran as it has worked well for many years for me and the blood issues I'm having haven't been proved to be caused by imuran.

Hi gilders,
Have u considered Rituxan?
imuran is a steroid sparring immunesuppressant and definitely, suppresses the bone marrow.
It suppressed my mom's bone marrow way to much on 100mg, but her nephrologist wants her back on it at a lower dose soon.
I hope your blood cells get better.

[cjhnsn29]

Loisann, I have been put on methrotrextate and had no problems so far. Yes ma'am you are one of the lucky ones. I am still ending up in the hospital or with infections and surgerys like there's no tommrrow. Be thankful you are doing great. Please stay that way. I am glad you are doing great. So I can only give you my opinion on methrotrextate I have to take 5 pills on Saturday morning. Good luck.:)

[mrtmeo]

Loisann, I have been put on methrotrextate and had no problems so far. Yes ma'am you are one of the lucky ones. I am still ending up in the hospital or with infections and surgerys like there's no tommrrow. Be thankful you are doing great. Please stay that way. I am glad you are doing great. So I can only give you my opinion on methrotrextate I have to take 5 pills on Saturday morning. Good luck.:)

Hi CJ,
Have u had your 25 hydroxy D3 test done to see if your levels are within the optimum range of 60-80ng/mL?
Vitamin D is our immune system modulating hormone.

[gilders]

Hi gilders,
Have u considered Rituxan?
imuran is a steroid sparring immunesuppressant and definitely, suppresses the bone marrow.
It suppressed my mom's bone marrow way to much on 100mg, but her nephrologist wants her back on it at a lower dose soon.
I hope your blood cells get better.

Hi mrtmeo,
During this latest relapse/flare after 3 months of imuran and pred there had been no improvement. Usually this combo works well for me. My main WG dr, who is also my kidney specialist, brought me in to hospital as an inpatient. I'd discussed Rtx with him and expected that this would be started whilst I was an inpatient. Instead of this a rheumatologist got involved and said the pred should have kicked in within a week of starting it, but Imuran can take 3 months to start to work. Therefore instead of starting Rtx, he had me begining my pred taper. I was very worried, but to be fair to the rheumatologist I did start to improve.
It's now another 7 month later but that short period of improvement stopped and I still don't feel like I'm in remission. I'm in the UK and can't afford private treatment so have to use NHS. The NHS is short of money so expensive treatment like Rtx isn't easy to access, although some areas it's easier than others.
I already have osteoporosis due to about 17 years of taking steroids.
I have also read that Rtx can become less effective the more it's used. If this is correct, then I'm ok with holding off it's use until I have a life threatening flare.

[mrtmeo]

Hi mrtmeo,
Instead of this a rheumatologist got involved and said the pred should have kicked in within a week of starting it, but Imuran can take 3 months to start to work.

That's good to know that it can take 3 months for Imuran to start working.
My mom's neph said that her imuran had started working when she was only on it for 2 weeks, but I don't know how he could tell it was working.
I hope your flare goes away.

[Katrina]

My mother has been on the Methotrexate in a shot every Friday and has also help with her maintanace of her remission .She has a loss of appetite and has lost a lot of weight and a lot of hair loss .Her Dr has doubled her folic acid to possibly help with the hair loss .But so far so good she hasn't relasped nor has she had to go back to hospital and believe me she is a walking testimony ! But prayer has worked and she is doing great other than that so stay strong and try to eat heathy (: prayers with you .

[mrtmeo]

My mother has been on the Methotrexate and has also help with her maintanace of her remission .She has a loss of appetite and has lost a lot of weight and a lot of hair loss .Her Dr has doubled her folic acid to possibly help with the hair loss . But prayer has worked and she is doing great other than that so stay strong and try to eat heathy (: prayers with you .

200 mg of B1 thiamin increases my mom's appetite.
If my mom is not able to eat enuf protein, I give her Bariatric Fusion.
It has 27gms protein, lowcarb and only needs 4 oz of liquid to mix with and I usually add a good quality oil like walnut.
Bariatric Protein & Gastric Bypass Protein | Bariatric Fusion (http://bariatricfusion.com/bariatric-protein.html)